| NPI | 1104656040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.029881) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2026-07-29 |